Meet the 2022 Healthcare Provider Champions - Latin America and the Caribbean
Sergio Augusto Melo de Siqueira Vieira nominated Dr Demetrius Montenegro for:
When the Ministry of Health’s programme for pre-exposure prophylaxis (PrEP) arrived in Brazil in 2017/2018, I told my endocrinologist, Dr Renata Paiva, that I was interested in participating because HIV had always been a concern for my generation. The idea of suffering and death caused by contracting the virus and developing AIDS had a lot of emotional impact on me and an entire generation of gay friends, now in their 40s-50s. My endocrinologist referred me to Dr Demetrius Montenegro because she knew him and the exceptional work he does in infectious diseases and with his clients.
At my first appointment with Demetrius, I immediately saw his reception, professionalism, ethics and empathy with his clients. Demetrius is the type of person who values responsibility in the development of his profession and welcomes his client without prejudice, labels or moral judgements. These qualities are dear and cherished by the LGBTQIA+ community, who are accustomed in their daily lives to the opposite.
I started using Truvada in 2018. Demetrius monitored me quarterly, with regular tests for HIV, syphilis and other markers that determine continued use of the medication. I had no reactions to the drug; my body tolerated it very well.
I stopped using Truvada when I was admitted with COVID-19 to the Real Hospital Português (RHP) in February 2021. I was hospitalized for 75 days in a very serious condition. I was intubated and then tracheostomized, and underwent rehabilitation processes, procedures to correct some pneumothoraxes, lung surgery (pleurodesis) and a neurological issue, which still affects my mobility.
Throughout this time, Demetrius did not leave my side. Along with the medical team from RHP, he cured me of COVID and was part of each step until I was discharged. Without his affection and professionalism, it would be very difficult to endure so much adversity.
I was able to resume the use of Truvada and resume my sex life. I continue to be accompanied by Demetrius, which makes me happy and confident in my choice to use the anti-HIV medication.
Dr Demetrius Montenegro: I am #DoingTheRightThing because…
First, I would like to thank you for this nomination. I was extremely honoured and happy for this recognition after 22 years of serving people with HIV and AIDS.
I remember something that happened years ago and marked me a lot. I was tending a client and we spoke about her personal problems. She told me: "Demetrius (not every client calls me doctor; I don't care about titles), I really like you because you are a person like us. You talk like us, look into our eyes and even dress like us. Sorry, but have you noticed that your shoe has a hole in the side?" We started laughing. I don't put up barriers, whether physical, social or intellectual, between myself and the people I tend to. Looking into their eyes, listening and smiling … maybe that's the difference. But that's part of who I am.
Before doing my residency in infectious diseases, I did a public health residency. During this residency, I realized that medicine was much more than what I had learned in medicine classes, which was focused on disease and signs and symptoms, and always forgot this relationship with the person and their social, family and mental health situation.
Caring is much more than prescribing medication. So, I consider my residency in public health as the turning point. The natural sequence was to work with stigmatized diseases, such as infectious diseases. In my daily practice, I have never looked into the eyes of a client to recriminate them or judge them for their attitudes.
To ensure adherence to treatment, it is important to understand the social situation and the environment of the client. With this information and knowledge, you then try to reach a compromise and accommodate their needs. You have to show that the figure of the health professional should not intimidate the client and that the relationship between the two is one of respect and trust. Studying, participating in national and international conferences, being aware of the main novelties on HIV, whether treatment, adherence or prevention … all of this is worthless if the infectious disease doctor does not have empathy.
Ivanize Vasconcelos nominated Nathalya Cristhine for:
I nominated Nathalya because she is an excellent professional who works with a lot of love. She treats clients humanely, making us feel welcome. I'm rooting for her to be chosen to receive this honour.
Nathalya Cristhine: I am #DoingTheRightThing because…
My turning point occurred in 2014 while I was training. I identified the features of women monitored at SAE IMIP that provided a profile of black, impoverished women with a low level of education in line with the Brazilian social structure.
I realized that caring for people with HIV and AIDS would not restrict the hegemony of the disease. It would mean coming across expressions of social issues (poverty, unemployment, lack of access to education, housing) and their impact on adherence to treatment. This would be my ethical and political commitment: to critically and empathically apprehend the singularities of realities that were different but similar in a context of daily violations.
More than intervening with qualified and empathic listening, I wrote about the experience in “Positive resistance: a context of feminization of the HIV/AIDS epidemic in Pernambuco”. Then I went to work for the Attitude Program, developing educational actions through a harm reduction vision with people on the streets using psychoactive substances and vulnerable to HIV acquisition.
In 2018, I started working on an AIDS Healthcare Foundation project to improve specialized services for people living with HIV in Pernambuco. I’m working at Hospital Universitário Oswaldo Cruz, monitoring new patients and those who have abandoned treatment (children, adolescents and adults). Once again, delving into the reasons for abandoning treatment, I find that vulnerability to HIV and AIDS is about race, gender and class. It is a programmatic and permanent vulnerability. In 2020, in the context of a pandemic, I started collaborating with the NGO, GTP+ for people living with HIV/AIDS, in a context of further regression of rights and disservice of the social protection network.
In monitoring so many cases, I found much non-acceptance of diagnosis, much abandoning of treatment and, unfortunately, many deaths. Many lives were taken by hunger.
Singer Elza Soares said: “From some ancestor of color, fight subtly for respect, fight bravely for respect, fight for justice and respect.”
Izabel nominated Dr Danielle Kelly for:
I nominated Dr Danielle Kelly because I value her as a competent professional. Her concern and care in the use of words of comfort made me not only accept the situation in which I was living, but also overcome the feeling of guilt brought with the stigma of the condition.
At first, it was necessary to perform many tests to monitor the stabilization of HIV. With each test, I felt more and more emotionally fragile. One necessary exam was gynaecological, and after three failed attempts to find a doctor, I finally met Dr Danielle.
When we met, I couldn't contain my tears. She told me her own stories, which, in a very sweet and understanding way, opened my eyes to the problems of the world and people's insecurity.
When I left the consultation, for the first time, I felt ready to face and understand HIV with a strong and open mind, always taking with me her phrase that most impressed me: “We must value each day of our lives and leave the future for later. Tomorrow does not belong to us.”
Dr Danielle Kelly: I am #DoingTheRightThing because…
I make a difference because I LOVE what I do so much. I work with unimaginable pleasure. I have an attachment to my pregnant women and they know what I mean.
My turning point took place in my childhood. When HIV was discovered, I had a very close relative who died – my grandmother. I remember, as a little girl, saying that I would work and live to help people like my grandmother. At the same time, I had the opportunity to get to know a speciality that I am completely passionate about: obstetrics. I was given the opportunity precisely because of my welcoming way to unite obstetrics with HIV. Today, I am completely fulfilled.
* To protect the identity of the nominator, a pseudonym is used.
Angel nominated Hyla Danniele Mendonça for:
I nominated Hyla Danniele Mendonça because she is a very attentive and careful professional with her clients. She is always ready to help and answer any questions. And she treats us very well and manages to calm us down.
The first time I went to see her, I was very nervous and desperate. She explained to me in an objective and clear way everything I needed to know. She calmed me down, telling me that everything was fine.
Without a doubt, she is an exemplary professional and others should be like her. She really loves what she does!
Hyla Danniele Mendonça: I am #DoingTheRightThing because…
I look at everyone who arrives to be welcomed as an individualized, subjective and unique person. We try to deconstruct their fears, anxieties, doubts and socially constructed taboos, and reconstruct with the client’s “knowledge” about the subject. I make a point of explaining how people acquire HIV, why this probably happened, and the care that will be necessary to maintain a healthy and full life.
A question I have heard the most is: "How long do I have to live?" Today, I anticipate this by saying that it is absolutely possible to live with HIV in a very calm way, and I show the ways that this can be made possible. This includes adherence to combination prevention methods: I promote the importance and effectiveness of PEP and PrEP, regular use of medication and monitoring of other pathologies through routine exams. I talk about other health services we have partnered with, about sexual partnerships and about mental health.
I offer the possibility of including partners later because I understand that it strengthens adherence and maintenance of treatment. I have a multi-professional and interdisciplinary team, which I understand makes all the difference to the quality of the care I provide; we often need to guarantee multidisciplinary care that includes psychology, social services or pharmaceutic professionals. I think that the factor I can guarantee in care is availability to build a unique therapeutic project, where every person who passes through feels that they are in a space that is for THEIR care.
My turning point came when I had been working for about eight years in the field of mental health. I was invited to change my sector and become a nurse at the Specialized HIV/AIDS Service (SAE) in Caruaru, an invitation that initially caused me some concern as I would be out of my comfort zone. I had always dedicated myself to and worked in mental health and teaching. I felt driven to learn and master the HIV and AIDS programme, which would become my passion.
I found incredible partnerships in the service, such as the programme coordinator, manager, psychologist, nursing staff and team in general. Yes, I need to reaffirm that my team is fantastic; there is a constant search for us to work in an increasingly aligned way, and this generates an even safer care space for the professionals and for clients. I started focusing on the subject, studied, took courses and kept learning every day in my daily clinical practice.
* To protect the identity of the nominator, a pseudonym is used.
Erik nominated Verónica Valencia for:
I have nominated Verónica Valencia, my psychologist and my support in a diagnosis that changed my life. Due to lack of information, I thought the result of my test would kill me in a second. But she was there to encourage me, hug me, explain the process and support me in everything that followed. She was with me for almost two hours when I was diagnosed because I panicked. It was a weekend in September 2017 and, worried about my reaction, Vero gave me her phone number and kept an eye on me the whole weekend without charging me a peso or asking for anything in return.
After that, Vero wrote to me almost every day to see how I was doing and to encourage me to take my medication. For almost two years, she did this, helping me build my self-esteem.
When I hit rock bottom, I wanted to start treatment as quickly as possible. She speeded up the process so that I could start my treatment. During this time, she always answered me quickly and gave me therapy at any time, whenever I had a crisis. Even in my depression, she made me smile.
Why did she do it? She did not know me. She did it simply for love of her work, because of what she thinks of each person, because she wanted to help without getting anything in return. Thanks to Vero, I am alive today. She continues to give me support whenever I need it. We have formed a friendship. To this day, I know that I cannot pay her for every message, word, scolding and hug that motivated me to love life and to love myself.
Over time, I saw how many people she helped. There were many of us: gay men, women, teenagers, everyone. Vero helped everyone.
I am not visible yet and I think I never will be. But I applaud all those who love their work to give dignity and love, work for equality and, above all, information to remove the stigma of this virus. Thank you, Vero ❤️.
Verónica Valencia: I am #DoingTheRightThing because…
When I started doing my social service, I realized that it was something that I liked and wanted to do. I started with the most basic things, like folding questionnaires given to clients who visited to be tested, and that allowed me to be able to see how they arrived and empathize with them.
When I finished my social service, the Coordinator of the Condesa Specialized Clinic, Dr Andrea González, invited me to be part of the project that she leads. This is how I have had the great fortune of being able to accompany people when they are diagnosed and see how they evolve in their process of accepting themselves. As I always say: “Turn poison into medicine.” At the same time, I see how they return to say thank you, how they have improved or that they are in treatment.
For two years, I have had the opportunity to work in the deputy directorate giving support to key populations, specific programmes and community integration. This has been without neglecting my clinical roles in other programmes. Without a doubt, the only way I have to give back so much is to be able to continue training as a person and a professional so that I can provide a better-quality service.
* To protect the identity of the nominator, a pseudonym is used.
Rodrigo Vazquez nominated Carlos Ahedo for:
I met Carlos Ahedo at Yaaj Mexico's LGBT+ Mexico Youth Group two years ago. He is the Director of Salud Positiva Yaaj, a programme to bring health professionals closer to the community in general and LGBTIQ+ youth in particular. I decided to approach Carlos in May last year when I received my diagnosis of HIV. He lives with HIV and part of his activist agenda is fighting for the rights of people living with HIV.
The support that Carlos gave me was very positive from the beginning. He asked how I was doing, how I was feeling, and if I needed help with anything in particular. I loved that he answered all my questions very calmly and with super-accessible language. Later, I made my appointment at the clinic and he was always aware of my progress. At his invitation, I joined the Positive Youth Network, a support space for people living with HIV.
In that space, I have been able to learn much more and listen to other people's stories. I thank Carlos for his willingness to help, his patience and the energy he dedicates to the fight for #PositiveHealth for everyone.
Carlos Ahedo: I am #DoingTheRightThing because…
I realized that the clinical-community approach to HIV is important because it removes healthcare and follow up of people with HIV from medicalized spaces, such as clinics or hospitals. It takes these services to spaces where it is easier to create strong bonds of trust between health providers and clients, creating synergy with other approaches and increasing the benefits for the population served.
Achieving therapeutic goals for people with HIV requires clients’ active and leading participation. This is essential in my profession of nursing. The focus for people living with HIV is consultation and counselling in relation to self-care; a multidisciplinary approach is the route to generate well-being and develop management of one's own health.
There is no exact moment of recovery and adherence. It is a continuous construction process that changes and adapts with each person provided with healthcare and nursing consultation.
I have a personal relationship with HIV: I have known for six years that I am living with it. It made me realize that my professional training alone is not enough for me to understand the phenomenon of HIV and that, like me, health professionals do not necessarily have the knowledge and awareness of how to provide dignified care of people with HIV. That is why I decided to make a difference and be professional in community care for HIV with a social perspective.
I do not neglect the clinical scientific knowledge of professional practice, but I create my own tools to face my new reality and become the kind of health provider that I would like to find myself, not only as a client, but also as a peer and teacher. So, I have learned from my work as a community nurse (T-lll health centre in CDMX), teacher (ESEO, IPN) and community promoter on HIV issues (Yaaj Mexico) that we have to influence new realities for people living with HIV and really provide the tools for building self-management of health.
Oscar Salvador Torres nominated Javier Martínez Badillo for:
I have nominated Javier Martinez Badillo because in addition to being my doctor, he is my friend. Thanks to this deep emotional bond, I have managed to adhere to my antiretroviral treatment and attend to any discomfort that I have faced in the almost six years that I have known him. With Javier, I have discovered that emotions are important in the processes of healthcare and that it is not just about the doctor reviewing your symptoms and prescribing substances to cure them. Your body is inseparable from your emotions.
For example, once, an injury did not heal even though I followed the instructions from Javiercito. In solidarity, he asked me a daily and forcefully: "How are you?" I could have interpreted this question as the typical words that we all use to show interest in others: sometimes feigned, sometimes real, sometimes just as a literary script of everyday life. I don't know what happened, but Javier's tone of voice and look clicked with my emotions when he also asked: “Why do you think that what you consider your main organ of pleasure does not heal?”
I was silent for a few seconds. Uncomfortable and uncertain, I made a journey inside myself and found the answer: the reason why my intimate part did not heal was because my ex believed that I slept with half of the City of Mexico. He always questioned my way of dressing, using offensive language. He went through my things, like my computer and my cell phone. Our separation was painful and left me scarred for several months to the extent that I did not want to interact sexually with other men. This was reflected in a resistance of my male part to heal.
Thanks to this reflection that I built with Javier's guidance, I began to be more aware my emotional discomfort. Finally, my male part was able to heal and I became more aware of how my emotions generate or aggravate symptoms. Months later, I got seborrheic dermatitis, which was a reflection of my soul ailments. Javiercito recommended that I start psychological therapy. So I did.
Javier Martínez Badillo: I am #DoingTheRightThing because…
I have acted free of stigma in my work because I know that it is important to connect with clients so that they feel trusted and respected. Care without stigma also consists of in-depth dialogue with the person using the healthcare services offered. I am an intermediary and a facilitator of healing: not only physical, but also emotional. That is why I believe that dialogue is central not only for knowing the physical discomfort of the person, but also to delve into their affective dimension.
Attending without stigma implies starting from the premise that I can help heal with my hands, heart and knowledge. Care without stigma is to do it from an equal relationship enriched by the connection of two souls: that of the health provider and that of the client.
Gerardo Cabrera nominated Iliana de los Angeles Pérez for:
I have nominated Iliana de los Angeles Perez because thanks to her work, we have brought information to people living with HIV from the point of view of their peers. She approached me to give training workshops to people in The Ambulatory Center for the Prevention and Care of AIDS and Sexually Transmitted Infections (CAPASITS). She also supported clients having difficulty in joining CAPASITS in a cordial manner, free from discrimination.
Iliana de los Angeles Pérez: I am #DoingTheRightThing because…
When clients asked me for support when they were being ejected, mistreated and discriminated against in different places – at home with their families and at work or in other institutions – I realized that I had the power in my hands to manage resources and empower them to fight for their rights. I saw results in their better quality of life.
The first time I had to explain to an adolescent about his test HIV-positive result, he started crying and asked me how he would live because his family was not going to understand him. He said that he was alone and did not know what to do. I was deeply moved, and I immersed myself more in the topic; I liked it so much and I tried to learn more every day.
I helped this adolescent through the process, from clarifying information and easing doubts to getting him treated at CAPASITS. It was very pleasing to realize that I could contribute to improving the quality of life of people living with HIV.